Value of Smear and PCR in Sputum and Bronchoalveolar Lavage in Culture Positive Pulmonary Tuberculosis.

Clauida Tueller, Prashant N. Chhajed, Carlos Buitrago, Reno Frei, Martin Frey,
Michael Tamm
American Jour of Respiratory & Critical Care Medicine. April 2004. Vol 169 (7) : A534

• AIMS
  To analyze the diagnostic yield of smear and PCR in the sputum and bronchoalveolar lavage (BAL) in patients with culture positive pulmonary tuberculosis.
  
  
• METHODS
  We analyzed 188 patients who were culture positive for pulmonary tuberculosis.
  
  
• RESULTS
  Of 188 patients, 117 (62%) were sputum smear or PCR positive, 17 (9%) were sputum smear or PCR negative and 54 (29%) did not produce sputum. So, bronchoalveolar lavage was performed in 71 (38%) patients (M:F 55:16; smokers 44; mean age 40 years; swiss origin 27). BAL smear or PCR was positive in 59/71 (83%) patients (BAL smear in 44, PCR in 52). 11 patients with smear negative BAL had positive PCR. Of the 17 patients who were sputum smear or PCR negative, BAL was smear or PCR negative in 7 (40%) patients. 49/54 (91%) non sputum producers were diagnosed by BAL smear or PCR. Overall, 12/71 (17%) patients were only culture positive. 3 patients had previous treated tuberculosis. Symptoms included cough (69%), weight loss (43%), night sweats (31%), fever (27%) and hemoptysis (11%) and dyspnea (12%). 17% patients were asymptomatic. 24% had bacterial co-infection. 18/71 (25%) patients had endobronchial abnormalities (acute bronchitis 10, hemorrhagic bronchitis 3, purulent bronchitis 4 and perforated caseous lymph nodes.
  
  
• CONCLUSION
  Combined use of BAL smear and PCR has a good diagnostic yield in patients with sputum smear or PCR negative tuberculosis or in patients without sputum production. Therefore, bronchoscopy with BAL considerably contributes to the rapid diagnosis of pulmonary tuberculosis.

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